The current approach to treatment of malignant bone tumors (literature review) (Part 2)

Authors

  • Oleg Vyrva

DOI:

https://doi.org/10.15674/0030-598720141117-126

Keywords:

malignant tumors, polychemotherapy, radiation therapy, methods for substitution of osteoarticular defects, tumor endoprosthesis

Abstract

In the second part of this literature review on treatment of bone tumors are considered up-to-date methods of polychemotherapy (PCT), radiotherapy (RT), and surgical replacement of post-resection bone defects. According to standard protocols of treatment they carry out PCT before and after surgery which is called neoadjuvant and adjuvant therapies respectively. The purpose of neoadjuvant PCT is tumor cell ruination and prevention of metastases development. The most reliable method of assessment of PCT impact on tumor pathologic process is the pathomorphological analysis of the resected tumor tissue. They use adjuvant PCT in the majority of patients with malignant tumors in combination with surgical removal. Absolute indication for this procedure is the corresponding histological grading tumor activity in accordance with the protocols of PCT. RT has got clear indications and they use it just in the treatment of certain sarcomas. The purpose of sparing resection surgery is achievement of local tumor control. Today up to 85 % of patients with tumors of the musculoskeletal system get different kinds of organ salvage operations, and among them 70 % of patients have more than 5-year survival. Each salvage surgery should have three stages: removal of the tumor, reconstruction of the skeleton, soft tissue reconstruction and adequate wound closure. For today, the main method of reconstruction of the skeleton after tumors resection became joint replacement owing to a strong fixation, simultaneous compensation of massive bone defects with preservation of motion in the joint, and a short period of rehabilitation. Development and improvement of methods for the replacement of bone and joints defects after removal of malignant tumors remains an urgent problem of current oncological  orthopaedic surgery.

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